坏死型视网膜母细胞瘤伴眼眶蜂窝织炎的MRI表现  

MRI Features of Necrotic Intraocular Retinoblastoma Associated with Orbital Cellulitis

作　　者：尹秋凤[1] 陈淑贤[2] 冯赟[1] 夏正荣[1] 郑慧[1] 桂婷[1] 刘明[1] 汪登斌[1] 李玉华[1] YIN Qiu-feng;CHEN Shu-xian;FENG Yun;XIA Zheng-rong;ZHENG Hui;GUI Ting;LIU Ming;WANG Deng-bin;LI Yu-hua(Department of Radiology,Xinhua Hospital,Shanghai Jiaotong University;Department of Oncology,Xinhua Hospital,Shanghai Jiaotong University)

机构地区：[1]上海交通大学医学院附属新华医院放射科 [2]上海交通大学医学院附属新华医院肿瘤科

出　　处：《中国医学计算机成像杂志》2020年第6期533-536,共4页Chinese Computed Medical Imaging

基　　金：上海市科学技术委员会(编号:16411968300);国家重点研发计划(子课题)(编号:2017YFC0109003);上海市科学技术委员会(编号:18411967500)。

摘　　要：目的:探讨肿瘤坏死型视网膜母细胞瘤伴眶周蜂窝织炎的MRI影像表现。方法:收集我院2015-2019年经病理证实的14例视网膜母细胞瘤伴眼眶周蜂窝织炎的MRI及病理资料,回顾性分析其影像学特征。结果:坏死型视网膜母细胞瘤在所有视网膜母细胞瘤中发病率为2.6%(14/539)。14例病例中,双眼发病3例,单眼发病11例,平均发病年龄22.8个月。临床表现为白瞳症伴眼睛发红或眼睑肿胀。MRI表现:眼球增大11/14(78.6%),青光眼5/14(36.4%),白内障10/14(71.4%),晶状体剥落10/14(71.4%),所有目艮内病灶平均最大长径为(19.75±3.69)mm;所有眼内肿瘤灶T1WI表现为混杂高信号、等信号为主,T2WI表现为混杂低信号为主;T1WI增强后所有病灶均无强化,均伴有眼环明显增厚伴强化明显,DWI表现为高信号或部分高信号8例、条索状混杂高信号3例、低信号3例,平均ADC值为(0.974±0.263)×10^(-3)mm^(2)/s。球后表现:视神经增粗2例,视神经周围鞘膜明显强化不伴视神经增粗者12例,所有患眼均出现眶周斑片状、条片状强化影,伴眼睑明显肿胀。42.9%(6/14)患眼肿瘤侵犯并穿透筛板,浸润筛板后视神经。结论:坏死型视网膜母细胞瘤伴眼眶蜂窝织炎发病率较低,其眼内表现及肿瘤影像特征与经典型不同,具有较特征的影像表现。坏死型视网膜母细胞瘤大多伴有眼内蜂窝织炎,筛板后视神经浸润发生率较高。Purpose:To investigate the MRI features of necrotic intraocular retinoblastoma associated with orbital cellulitis.Methods:Fourteen patients with necrotic intraocular retinoblastoma associated with orbital cellulitis from 2015 to 2019 in our hospital were included and retrospectively analyzed.All cases underwent MRI scan preoperatively and were confirmed by pathology results.Results:The incidence of necrotic retinoblastoma associated with orbital cellulitis was 2.6%(14/539)in all retinoblastomas.Of 14 patients,there were 3 cases with bilateral retinoblastoma and 11 cases with unilateral retinoblastoma,with a mean age of 22.8 months.All patients presented leucocoria with conjunctival congestion and swelling of the eyelids.Of 14 affected eyes,MRI findings included:affected eyeball enlargement in 11 eyes,eyeball glaucoma in 5 eyes,cataract in 10 eyes,lens exfoliation in 10 eyes.Of 14 affected eyes,all the intraocular tumors showed high or medium signal intensity in T1WI and low signal intensity in T2WI.The contrast-enhanced T1WI showed non-enhancement in intraocular tumors and intense enhancement of eye ring.All tumors showed low or slight high signal intensity in DWI with ADC value of(0.974±0.263)×10^(-3)mm^(2)/s.Retrobulbar MRI findings included:optic nerve thickening in 2 cases,optic nerve sheath enhancement without optic nerve thickening in 12 cases,periorbital speckle or strip enhancement with obvious eyelid swelling in all eyes.The ethmoid plate was invaded,and penetrated and the optic nerve was infiltrated in 42.9% affected eyes.Conclusions:The incidence of necrotic retinoblastomas with orbital cellulitis is low.The necrotic retinoblastomas with orbital cellulitis have more characteristic imaging features,which are different features from those of the typical ones.Most of the necrotic retinoblastomas are accompanied by intraocular cellulitis,and with a high incidence of optic nerve infiltration.

关 键 词：磁共振成像 视网膜母细胞瘤 眼眶蜂窝织炎 

分 类 号：R445.2[医药卫生—影像医学与核医学]